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Abstract Details

The Effectiveness of Neurologic Telehealth Outpatient Care During the COVID-19 Pandemic
Practice, Policy, and Ethics
P1 - Poster Session 1 (8:00 AM-9:00 AM)
10-001
To assess the adequacy of telehealth evaluation as compared to in-person evaluation in neurologic clinic visits.
The Covid-19 pandemic offers an opportunity to evaluate telehealth visits to inform future care delivery.
The full study will be a multi-institutional retrospective analysis of neurologic care at six academic health centers; this abstract reports data from one institution, the University of Michigan. We compared neurologic patients with a telehealth new patient visit (cases) to patients with an in-person new patient visit (controls) from September 2020-December 2021. The primary interest was adequacy of telehealth evaluation, thus the primary outcome was a follow-up neurologic clinic visit within 90 days (likely faster than standard follow-up). Emergency room (ER) visits and hospitalizations for neurologic diagnoses following the initial clinic visit were also assessed. Outcomes were measured across several neurologic diagnosis categories (e.g., epilepsy, stroke, headache). Propensity score matching by diagnosis, demographics, and prior healthcare utilization was conducted to reduce bias in care modality selection.
We identified 4,336 telehealth and 4,690 in-person neurologic patients with new patient visits resulting in 3,074 cases and 3,074 controls following propensity score matching. There was no significant difference in follow-up neurologic clinic visits within 90 days between telehealth and in-person new patient visits (18% vs. 16.2%, p=0.06). ER visits occurred less frequently in the telehealth cohort (0.6% vs. 1.1%, p=0.03); no increase in hospitalizations was seen in the telehealth cohort (2.3% vs. 2.5%, p=0.74). Future exploration with the multi-institutional cohort will examine differences in care patterns by neurologic diagnosis.
There were no differences in follow-up clinic visits between telehealth and in-person neurologic new patient visits. While residual confounding likely exists, these results suggest that large differences in subsequent healthcare utilization are unlikely. There may be important differences by neurologic diagnosis, which will be evaluated in subsequent work.
Authors/Disclosures
Chloe E. Hill, MD (University of Michigan)
PRESENTER 		The institution of Dr. Hill has received research support from NIH. The institution of Dr. Hill has received research support from AAN. The institution of Dr. Hill has received research support from NIH. Dr. Hill has a non-compensated relationship as a member of AAN Health Services Research Subcommittee with AAN that is relevant to AAN interests or activities.
Chun Chieh Lin, PhD (The Ohio state University) The institution of Dr. Lin has received research support from AAN. The institution of Dr. Lin has received research support from Genentech Inc. The institution of Dr. Lin has received research support from NIH.
Ellen Anderson-benge (好色先生) Ellen Anderson-benge has received personal compensation for serving as an employee of 好色先生.
Christine D. Esper, MD, FANA, FAAN (Emory Brain Health Center) Dr. Esper has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Parkinson's Study Group. Dr. Esper has received research support from Centers for Disease Control and Prevention. Dr. Esper has received research support from Michael J. Fox Foundation. Dr. Esper has received research support from McCamish Parkinson's Disease Innovation Program. Dr. Esper has received publishing royalties from a publication relating to health care.
Kavita Nair, PhD, FAAN (University of Colorado) Dr. Nair has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bristol Meyers Squibb. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Nair has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for PhRMA Foundation. Dr. Nair has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. Dr. Nair has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for MJH Lifesciences. Dr. Nair has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Anylam . Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Applied Patient Experience. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Esai. Dr. Nair has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for MHJ Life Sciences. Dr. Nair has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sanofi-Genzyme. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for ICER. The institution of Dr. Nair has received research support from Genentech. The institution of Dr. Nair has received research support from Novartis. The institution of Dr. Nair has received research support from Genentech. The institution of Dr. Nair has received research support from Phrma Foundation. The institution of Dr. Nair has received research support from Bristol Meyers Squibb. The institution of Dr. Nair has received research support from Novartis. The institution of Dr. Nair has received research support from NINDS. The institution of Dr. Nair has received research support from Sanofi Genzyme. The institution of Dr. Nair has received research support from Kyverna Therapeutcis. Dr. Nair has a non-compensated relationship as a Board Member with Center for Improving Value in Healthcare that is relevant to AAN interests or activities.
Adam De Havenon, MD, FAAN (Yale University) Dr. De Havenon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novo Nordisk. Dr. De Havenon has or had stock in Certus.Dr. De Havenon has or had stock in TitinKM. The institution of Dr. De Havenon has received research support from NIH/NINDS. Dr. De Havenon has received publishing royalties from a publication relating to health care.
Neil A. Busis, MD, FAAN (NYU Langone Health) Dr. Busis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for 好色先生. Dr. Busis has received personal compensation in the range of $0-$499 for serving as a Consultant for American Medical Association. Dr. Busis has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology Today. Dr. Busis has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology Clinical Practice.
Gregory J. Esper, MD, MBA, FAAN (Emory University) Dr. Esper has or had stock in NeuroOne Medical Technologies, Inc.Dr. Esper has or had stock in Focused Cryo, Inc. The institution of an immediate family member of Dr. Esper has received research support from Centers for Disease Control. The institution of Dr. Esper has received research support from Health and Human Services Assistant Secretary for Preparedness and Response. An immediate family member of Dr. Esper has received publishing royalties from a publication relating to health care.
Brian Callaghan, MD, MS, FAAN (University of Michigan Health System) Dr. Callaghan has received personal compensation for serving as an employee of University of Michigan. Dr. Callaghan has received personal compensation for serving as an employee of Ann Arbor Veterans Affairs. Dr. Callaghan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Dynamed. Dr. Callaghan has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for 好色先生. Dr. Callaghan has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Medico-legal work. Dr. Callaghan has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Vaccine Injury Compensation Program. The institution of Dr. Callaghan has received research support from 好色先生. The institution of Dr. Callaghan has received research support from JDRF. The institution of Dr. Callaghan has received research support from NIA. Dr. Callaghan has received personal compensation in the range of $500-$4,999 for serving as a Grant Reviewer with NIH.